Structural Empowerment and Patient Safety Culture of Nurses
Working in Critical Care Units
Donna Armellino RN; Division of Infectious Diseases, Department of Medicine, North Shore University Hospital
Medical errors have become a major national concern. The Institute of Medicine (IOM) reported in 1999 that an estimated one million people are injured by errors in treatment at hospitals in the United States, with an estimated 120,000 deaths arising from those errors (Kohn, Corrigan, & Donaldson, 2000). Preventable events that cause errors resulting in pain and suffering are reported in the media, on television and broadcast radio, and in newspapers and journals. Unfortunately, these are reports of patients who came to the hospital for care and were harmed by that care (Donchin et al., 2003; Hayward & Hofer, 2001). Medical errors are failed processes that are clearly linked to adverse outcomes (Hofer & Kerr, 2000). Human error may be the result of system failures related to how a process is designed, the structure of the organization, incompetence due to employee experience and training, or related to equipment failure. Systems are created and supported by leaders within an organization. Leaders can redesign workplace processes, structures, training, and equipment maintenance procedures to eliminate medical error resulting from human error. Errors decrease and safety increases when human error is considered within system design (Galvan, Bacha, Mohr, & Barach, 2005).
Safety can be considered when an individual is protected from accidental injury (Kohn at al., 2000). High-risk industries, such as aviation, are making use of human factor engineering (HFE). Using a human error approach, safety improvements have been demonstrated in aviation by improving systems (Wiegmann, Zhang, von Thaden, Sharma, & Mitchell, 2004). With HFE, it is assumed that people make errors and that systems are devised to control for human error. In health care, the work environment has been redesigned to decrease medical errors and increase safety. Creating processes that factor in human error has had a positive influence on medical errors involving medication administration, anesthetic practices, specimen mislabeling, drug events, wrong site surgery, hospital-acquired infections, and surgery (Cooper, Newbower, Long, & McPeek, 2002; Galvan et al., 2005; Micheals et al., 2007; Pronovost et al., 2006; Quillen & Murphy, 2006). Decreasing errors through redesign of the registered nurses (RNs) work environment has increased patient safety.
Changing the nurse’s work environment has been shown to influence patient outcomes. Needleman, Buerhaus, Mattle, Stewart, and Zelevinsky (2002) used administrative data from 799 hospitals in 11 states to report the relationship between increased hours of nursing care per day by RNs and rates of adverse outcomes. Aiken, Clarke, Sloane, Sochalski, and Silber (2002) associated patient-to-nurse ratios and patient mortality rates among 232,342 adult patients discharged from two hospitals in Pennsylvania. Whittaker, Smolenski, and Carson (2000) discussed increased medical errors in patients when care is rendered by nurses who are not certified. Research involving 866 surveys from nurses in 25 critical care units within eight hospitals in southeastern Michigan suggested that lack of power may contribute to less desired patient outcomes (Manojlovich & DeCicco, 2007).
It has been reported that empowered nurses report a high quality of nursing care on their units (Upenieks, 2003), and nurses with increased authority on issues such as safety, cost
Structural Empowerment and Patient Safety Culture of Nurses Working in Critical Care Units Clinical Science Research
effectiveness, and care exhibit increased empowerment (Parsons, 1998). Health care, like aviation, is a potentially hazardous...